Addendum: Sample Laxative Protocol

Most cancer patients will experience constipation at some time
during the course of their illness. The goal of a bowel regimen is
to prevent constipation when possible and then to treat it when
necessary. The nutritional guidelines of a diet high in fiber and
fresh fruits and vegetables as well as the intake of 6 to 8 glasses
of water per day may prevent the need for laxatives. Check with the
patient's doctor before recommending any brand of laxative or any
change in laxative.

The following protocol sheet may be helpful for your patient
and their care givers. After conferring with the physician, fill in
the appropriate brand and dose of medication and leave this sheet in
the house with the patient.

Laxative Protocol

Many prescription medications can cause constipation. Bowel
function is also affected by activity and diet. For example, regular
doses of narcotic pain-relieving medication frequently cause
constipation. A medication regimen that also includes use of a
laxative is almost always required to prevent constipation.

A daily bowel regimen should be followed just as carefully as your
doctor's other instructions. The overall goal is to have a bowel
movement approximately every days(s). Because responses
vary, use the guidelines below to find a regimen that works best for
you. If at any time the dosage of your pain-relieving medication is
changed, you may also need to increase or decrease your daily dosage
of laxative. See your doctor for a change in dose.

1. Take

at bedtime,

Brand and dose

If you do not have a bowel movement in the morning,

2. Take

after breakfast.

Brand and dose

If you do not have a bowel movement by evening,

3. Take

at bedtime.

Brand and dose

If you do not have a bowel movement in the morning,

4. Take

after breakfast.

Brand and dose

If there is no bowel movement within 48 hours after starting this protocol,

5. Add after breakfast, while continuing to take in the morning and tablets in the evening.

If there is no bowel movement within hours after beginning this protocol, please consult your physician for additional instructions.

Once you start have bowel movements, use the two steps prior to
your last one as your daily laxative protocol. For example, if you
achieved a bowel movement after Step 4, use Steps 2 and 3 (that is,
(3) in the morning and at bedtime) as your daily regimen.

Remember, constipation is a common side effect of many
medications. A daily bowel regimen helps to prevent this potentially
troublesome side effect.

If you are unsure about what to do, please call your physician for
advice.